{"componentChunkName":"component---src-components-article-page-article-page-gatsby-container-tsx","path":"/articles/cycle-a-z/heavy-periods-how-to-tell-if-your-heavy-periods-are-normal","result":{"data":{"articleNode":{"id":"78StIDZQl2ykGUEkISgEOe","title":"What is a heavy period?","subtitle":"Find out whether you’re experiencing heavy menstrual bleeding.","seoMetaTitle":"Heavy Periods: How to Tell if Your Heavy Menstrual Bleeding Is “Normal”","seoMetaDescription":"Learn about the symptoms of heavy menstrual bleeding, its potential causes, and when to see a healthcare provider for help","openGraphTitle":"When Are Periods Considered Heavy?","openGraphDescription":"Clue looks at the latest research on heavy menstrual bleeding and possible causes","slug":"cycle-a-z/heavy-periods-how-to-tell-if-your-heavy-periods-are-normal","artCredits":"Illustrations by Emma Günther","publishDate":"2024-04-19T00:00+01:00","updatedAt":"2025-08-19T15:06:57.330Z","createdAt":"2017-11-09T10:25:08.728Z","locale":"en","authors":[{"id":"5TxGBeuJfNhCrCTp0vppCp","name":"Maggie Aime, MSN, RN","headline":"Science writer","slug":"maggie-aime-msn-rn","twitter":null,"locale":"en","profileImage":{"id":"6NU0ufbFXBckmeSUFGVzAy","description":"","file":{"contentType":"image/png","url":"//images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png"},"gatsbyImageData":{"images":{"sources":[{"srcSet":"https://images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png?w=225&h=225&q=50&fm=webp 225w,\nhttps://images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png?w=450&h=450&q=50&fm=webp 450w,\nhttps://images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png?w=900&h=900&q=50&fm=webp 900w","sizes":"(min-width: 900px) 900px, 100vw","type":"image/webp"}],"fallback":{"src":"https://images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png?w=900&h=900&q=50&fm=png","srcSet":"https://images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png?w=225&h=225&q=50&fm=png 225w,\nhttps://images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png?w=450&h=450&q=50&fm=png 450w,\nhttps://images.ctfassets.net/juauvlea4rbf/6NU0ufbFXBckmeSUFGVzAy/71ac804a333cc97789529584011f0c7e/Maggie_Aime.png?w=900&h=900&q=50&fm=png 900w","sizes":"(min-width: 900px) 900px, 100vw"}},"layout":"constrained","backgroundColor":"#685858","width":900,"height":900}}},{"id":"49WGqODWcggski24MkSYAu","name":"Prof. Dr. Malcolm G. Munro MD, FRCS(c), FACOG1","headline":"Clue medical board member, professor and medical doctor","slug":"prof-dr-malcolm-g-munro-md-frcsc-facog1","twitter":null,"locale":"en","profileImage":{"id":"3IGwQ5taf5AMmBfol0AXm4","description":"","file":{"contentType":"image/png","url":"//images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png"},"gatsbyImageData":{"images":{"sources":[{"srcSet":"https://images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png?w=225&h=225&q=50&fm=webp 225w,\nhttps://images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png?w=450&h=450&q=50&fm=webp 450w,\nhttps://images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png?w=900&h=900&q=50&fm=webp 900w","sizes":"(min-width: 900px) 900px, 100vw","type":"image/webp"}],"fallback":{"src":"https://images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png?w=900&h=900&q=50&fm=png","srcSet":"https://images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png?w=225&h=225&q=50&fm=png 225w,\nhttps://images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png?w=450&h=450&q=50&fm=png 450w,\nhttps://images.ctfassets.net/juauvlea4rbf/3IGwQ5taf5AMmBfol0AXm4/e00b8e4b5f76e981bdecb3ec31967dd7/Clue_Authors.png?w=900&h=900&q=50&fm=png 900w","sizes":"(min-width: 900px) 900px, 100vw"}},"layout":"constrained","backgroundColor":"#f8f8f8","width":900,"height":900}}}],"reviewers":[{"id":"79ol3Fjk3t3uSQDChFbOjj","name":"Magdalena Geretto, MD, MSc","headline":"Science writer","slug":"magdalena-geretto-md-msc","twitter":null,"locale":"en","profileImage":{"id":"3J03SzcwotOSa1YC0qUYlO","description":"","file":{"contentType":"image/png","url":"//images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png"},"gatsbyImageData":{"images":{"sources":[{"srcSet":"https://images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png?w=225&h=225&q=50&fm=webp 225w,\nhttps://images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png?w=450&h=450&q=50&fm=webp 450w,\nhttps://images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png?w=900&h=900&q=50&fm=webp 900w","sizes":"(min-width: 900px) 900px, 100vw","type":"image/webp"}],"fallback":{"src":"https://images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png?w=900&h=900&q=50&fm=png","srcSet":"https://images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png?w=225&h=225&q=50&fm=png 225w,\nhttps://images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png?w=450&h=450&q=50&fm=png 450w,\nhttps://images.ctfassets.net/juauvlea4rbf/3J03SzcwotOSa1YC0qUYlO/dbd66ad694fdc1eb98cb3a23e1aff027/Magdalena.png?w=900&h=900&q=50&fm=png 900w","sizes":"(min-width: 900px) 900px, 100vw"}},"layout":"constrained","backgroundColor":"#481818","width":900,"height":900}}}],"editors":null,"featuredImage":{"description":"","file":{"contentType":"image/svg+xml","url":"//images.ctfassets.net/juauvlea4rbf/2v3VqJeUSu67azpiMB4LUM/94da2fb104955f73cc8a496e5a632588/Contentful__1_.svg"},"gatsbyImageData":null},"openGraphImage":{"description":"Illustrations of a menstrual cup full of menstrual blood","file":{"url":"//images.ctfassets.net/juauvlea4rbf/qgzdScst2KGiiSCoauSWy/3da0aca2155b1503a57e37a5edd76eaf/FB__17_.png"}},"sectionDivider":null,"featuredVideoURL":null,"category":{"id":"4zjthp6LJMfoiYDdWpEt03","slug":"bleeding","title":"Bleeding","color":null,"description":{"description":"Articles about Bleeding."},"parentCategory":{"title":"Menstrual Cycle","slug":"menstrual-cycle"},"locale":"en"},"body":{"body":"Menstruation varies from person to person, making it harder to distinguish\nnormal from excessive blood loss. So how do you tell what is “normal?”\n\n**Let’s get medical:** In clinical research studies, the symptom of heavy\nmenstrual bleeding (HMB) is defined as **blood loss larger than 80 mL per\ncycle**.\n\nHowever, blood loss can be very hard to measure, unless you use a menstrual cup.\nAnd even if you lose less than 80 mL, it can still affect your quality of life,\nparticularly if the timing of your periods is irregular and, therefore,\ndifficult to anticipate. Consequently, the more accepted and practical\ndefinition of HMB is **“excessive menstrual blood loss which interferes with a\nwoman’s physical, social, emotional and/or material quality of life.”**(National Institute for Health and Care Excellence or NICE)\n\n### Causes of Heavy Menstrual Bleeding\n\nThere are a variety of conditions that can cause HMB. The most common conditions\ninclude:\n\n* **Polyps**, or growths in the uterine lining, usually cause spotting or bleeding\nbetween periods and sometimes HMB.\n* **Adenomyosis**, the abnormal growth of uterine lining (endometrium) into the\nmuscular wall of uterus, but can sometimes cause heavy and/or painful periods.\n* **Uterine fibroids**, benign growths (smooth muscle tumors) on the uterus, also\nknown as *leiomyomas*, can sometimes cause HMB. If they grow in the uterine\nlining (endometrium) they will most likely cause HMB.\n* **Cancers and precancers** are very uncommon, but important, causes of abnormal\nbleeding, particularly for individuals under the age of 40. While they can cause\nHMB, cancers and precancers more likely cause irregular bleeding or bleeding\nbetween periods.\n* **Coagulopathy,** an inherited disorder preventing the blood from clotting\nnormally, will cause HMB usually from menarche (the first period).\n* **Ovulatory disorder**, the absence or irregularity of ovulation, is a\nhormonal problem that may cause irregular bleeding that may or may not include\nHMB as a symptom.\n* **Endometrial disorder,** an abnormality in the lining of the uterus, prevents\nthe tissues from stopping the bleeding normally.\n\nMost medications and birth control pills don’t cause HMB, but there are two\nexceptions: **Copper-containing intrauterine devices** may increase the amount\nof blood lost during menstruation and **anticoagulants (“blood thinners”)**,\nwhich prevent blood clots, usually cause HMB.\n\n### Do you have Heavy Menstrual Bleeding?\n\nUnderstanding whether or not you suffer from HMB requires the accurate recording\nof your menstrual history. The intensity of bleeding varies from person to\nperson, so determining what is clinically heavy is tricky. Furthermore, while a\nsingle period can be heavy, a real problem isn’t likely to exist unless the HMB\nis present at least most of the time. *The medical definition of this is when\nHMB is present for the majority of periods within the previous six months*.\nEntering your bleeding intensity diligently and correctly in the [Clue\napp](http://helloclue.com/) will make it easier to assess if bleeding qualifies\nas heavy.\n\nYour healthcare provider may ask you how many (and what size) pads/tampons you\nhave been using in one day. Also, blood clots are very important to note — their\nsize, number and color. They contain blood, and it is important to measure and\ncount them to get an approximation of how much blood has been lost.\n\n1. Distinguish between regular and maxi tampons or pads, as maxi can usually absorb\ntwice more than regular (each maxi tampon or pad should be counted as two\nregulars).\n1. Check how soaked your tampon or pad is. Is it fully soaked with blood, or just\nhalf? (For half soaked, divide the number of half soaked pads by two.)\n1. Count blood clots; they contain blood too.\n1. For a menstrual cup, check the volume capacity and measure how full the cup is\n(e.g. if it is a 10 mL cup and it is ¾ full, the amount of the blood your\nmenstrual cup contains is 7.5mL).\n1. If the number of soaked tampons or pads is **sixteen or more** for the entire\nduration of your period (or **eight fully soaked maxi tampons or pads**), then\nyour flow is heavy.\n1. If you note 80mL or more blood with your menstrual cup for one entire cycle,\nyour flow is heavy.\n\n**Here are some more guidelines to determine if what you are experiencing is heavy:**\n\n1. Your menstrual period lasts longer than seven days.\n1. Your flow soaks through tampons or pads every hour for a few hours in a row.\n1. You need to change pads or tampons during the night.\n1. You have multiple grape-sized (or larger) blood clots.\n1. Your heavy menstrual flow keeps you from doing things you would normally do.\n1. You are tired, have a lack of energy or are short of breath.\n1. You feel heavy pain in your abdomen and lower back.\n\n![heavy-menstrual-bleeding](//images.contentful.com/juauvlea4rbf/tihl23Lhw4OegsWOkU0qE/aeb47450414eda363514509f4145acb1/heavy-menstrual-bleeding.png)\n\nMake an appointment with your gynecologist if your menstrual bleeding seems\nheavier than usual, or if it lasts more than seven days or impacts your life.\n\nIf you experience bleeding between periods, during or after sex, during\npregnancy or after you have entered menopause, it is important to visit your\ngynecologist.\n\n### Possible consequences of Heavy Menstrual Bleeding\n\nWhenever you have a period, you lose blood. For those with normal bleeding, and\na diet containing normal amounts of iron, blood loss and iron intake should be\nin balance. However, for those with heavy menstrual bleeding, and especially\nwhen the diet is deficient in iron, blood loss can exceed iron intake and may\nresult in an **iron deficiency and possible low red blood count, or anemia**. Iron deficiency, with or without anemia, can cause fatigue and interfere with\nthe ability to concentrate, exercise, and, enjoy life in general.\n\n### What should I do about it?\n\nTo treat HMB, you and your healthcare provider need to determine its cause or\ncauses. This can be done by a few simple tests including a blood test, a\ntransvaginal ultrasound and/or taking a sample tissue from the uterine lining\n(endometrial biopsy).\n\n**Polyps:** Surgical removal of the polyp is the most effective therapy.\n\n**Adenomyosis:** Treatment with hormonal contraception, especially an\nintrauterine device that releases a hormone called progestin.\n\n**Fibroids:** Some medical or hormonal therapies are effective, although\nprocedures involving surgery are often necessary.\n\n**Cancer or pre-cancer:** Most pre-cancers can be treated with medication, but\ncancers usually require surgery.\n\n**Blood clotting disorder:** Tranexamic acid or hormonal medications are the\nusual treatment strategy.\n\n**Ovulatory disorders:** Ovulatory disorders can generally be treated with\nhormonal medication such as progestins or other hormonal contraceptive\nmedications.\n\n**Endometrial disorders:** People with endometrial disorders can respond well to\ntranexamic acid, use of simple NSAIDs like ibuprofen, naproxen or mefenamic\nacid, the progestin-releasing intrauterine system or other types of hormonal\ncontraception. When a copper intrauterine device is the cause, some of the\ntreatments for endometrial disorders can be effective.\n\n**Iron deficiency:** Whenever there is an iron deficiency, and especially if\nthere is anemia, an iron replacement should be part of the treatment.\n\nSurgery can be important especially for removal of polyps or fibroids since it\ncan be performed simply and in a way that preserves fertility. Finally, invasive\nsurgery (such as endometrial ablation and hysterectomy) is the last resort to\nhelp with the HMB, but is always carefully considered as these procedures can\nremove your chances to bear children.\n\nIf you suspect you might have HMB, contact your healthcare provider immediately.\nThis condition is easily treated in most of the cases. Early detection and\ndiagnosis will make treatment more successful and less invasive.\n\nIf you are still unsure if you have HMB, try to track more details during your\nnext cycle, and analyze it afterwards. If you note any of the signs we have\nmentioned here, book an appointment with your healthcare provider.\n"},"bodyRichText":{"raw":"{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Top things to know: \",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Heavy menstrual bleeding is when excessive bleeding negatively impacts a person’s quality of life\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Symptoms include frequently soaking through menstrual products, large blood clots, and periods lasting longer than eight days\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Most individuals with heavy menstrual bleeding are iron deficient, and many have iron deficiency anemia; circumstances that typically negatively impact cognitive and physical function\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Potential causes include bleeding disorders (like von Willebrand Disease), adenomyosis, certain types of fibroids, and changes to the uterus’ ability to stop bleeding\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Treatment options vary depending on the cause of the heavy menstrual bleeding, the degree and severity of iron deficiency, and someone’s immediate and future desires regarding pregnancy\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"}],\"nodeType\":\"unordered-list\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"For many people, periods are manageable with minor inconveniences. But for others, heavy periods can impact work, school, relationships, and daily life, especially if they result in \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"iron deficiency\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" (ID) or its more severe form, \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"iron deficiency anemia \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\"(IDA). Heavy menstrual bleeding (HMB) is actually a set of symptoms known collectively as \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"abnormal uterine bleeding \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\"(AUB). AUB also includes disruptions to the frequency, duration, and regularity of menstrual bleeding (1). \",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"HMB isn’t defined by a healthcare provider but by you, if the volume of your periods adversely impacts the activities and quality of your daily life (2). It's a common problem, affecting up to five out of ten women during their reproductive years (3). The good news is that effective treatments for HMB and ID/IDA exist and are readily available (4,5).\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"1jCaKiuJgeFMJNCUU0nG98\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[],\"nodeType\":\"embedded-entry-block\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"What is heavy menstrual bleeding? \",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"While \",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"4U1VNSG648c2aWS6Goc6UW\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"periods vary \",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\"from person to person, determining whether you have HMB is as simple as evaluating the impact of your period bleeding volume on your daily life (6). Occasional periods can indeed be heavy and bothersome, but if most of your periods adversely affect your quality of life, you probably have HMB (4,6). Another component of menstruation that can adversely affect your quality of life is the amount of \",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"4AmqXMvGv6Q2yusUeACMmQ\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"pain associated with the period\",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\", called \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"dysmenorrhea \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\"(7). While not HMB, there are also many simple and effective ways to treat dysmenorrhea, many of which also treat heavy bleeding (depending on the underlying cause) (2).\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"6r4Q0GEhBTymM4Q8fY3BrJ\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[],\"nodeType\":\"embedded-entry-block\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"The following list outlines symptoms that might suggest you’re losing more blood than expected (5,6,8):\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Your menstrual bleeding lasts for more than eight days\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You soak through your tampons or pads every one to two hours\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You use more than one pad at a time to manage your menstrual flow\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You have to use two menstrual products simultaneously, like a pad and a tampon, because you soak through\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You must change pads or tampons throughout the night or frequently wake up to empty your\",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"X3Dkma9HEcCcU20yEWGcm\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[],\"value\":\" \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"underline\"}],\"value\":\"menstrual cup\",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\"\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You need to empty your menstrual cup more regularly than the packaging suggests\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You pass\",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"3DsU3uVhDOUioMQmwguOUw\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[],\"value\":\" \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"underline\"}],\"value\":\"blood clots\",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\" that are larger than the size of a quarter or 10p coin during your menstrual period\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Your heavy menstrual flow interferes with your daily activities, such as exercise, or causes you to take time off work or school\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You feel tired, lack energy, or have shortness of breath throughout the month, including during your periods\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"You feel heaviness or pain in your abdomen and lower back\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Your sleep is disrupted by heavier, unpredictable periods (9)\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Your heavy period disrupts work, school, or your social activities (10,11)\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Your heavy menstrual bleeding has an emotional impact - you feel stressed, anxious, or depressed due to the physical discomfort and lifestyle disruptions it causes (12,13)\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Your libido is reduced and you engage in sexual activity less due to the physical discomfort and bleeding associated with HMB (14)\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"}],\"nodeType\":\"unordered-list\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"If any of these experiences sound familiar or happen regularly, you might have HMB. It may be a good idea to speak to your healthcare provider. They can help you determine what may be causing it and discuss potential treatment options (2). Keeping track of your period and associated experiences can help you understand HMB (15). \",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Causes of heavy menstrual bleeding \",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"If you’re worried about how much you bleed on your period, getting a check-up with a healthcare provider is important, as it may have an underlying cause (6,15). Sometimes, heavy periods can result from medical conditions affecting your uterus, ovaries, hormones, and other health problems (6). \",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"The potential causes of abnormal uterine bleeding or heavy menstrual bleeding are described in the table below (2,5,6,16,17,18):\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"m2WA54W5PN2WbveAw4VH7\",\"type\":\"Link\",\"linkType\":\"Asset\"}}},\"content\":[],\"nodeType\":\"embedded-asset-block\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Iron deficiency and iron deficiency anemia\",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Prolonged heavy periods usually lead to iron deficiency (ID) and, subsequently, to iron deficiency anemia (IDA) (10). This happens when you lose more blood than you can replace with the iron you get from your diet, even if you take oral supplements.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"7kktuaIkuP8ELjxARzcUN1\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[],\"nodeType\":\"embedded-entry-block\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Iron is essential to many bodily processes, including supporting muscular and brain function. Consequently, fatigue, difficulty concentrating, and reduced physical function may occur even when someone is at the ID stage and not yet with IDA (10,19). Once anemic, the symptoms can worsen including shortness of breath due to a lack of essential oxygen-carrying red blood cells (10,20). \",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Your healthcare provider will likely prescribe iron therapy to treat ID or IDA. In most instances, people will receive tablets they take daily or every other day. Some people who have very low iron levels or can’t take medication orally may need to receive \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"intravenous\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" iron (where iron is given directly into the bloodstream via a vein)(10).\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"What can I do about heavy menstrual bleeding? \",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Living with heavy periods can be difficult, but having these experiences doesn't mean you have to accept a lower quality of life. While HMB impacts one or more of your physical health, emotions, relationships, and daily activities, support and treatment options are available.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"5PQGdjuX1d7JqYAE3I7bGV\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[],\"nodeType\":\"embedded-entry-block\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"The first step is being open with your healthcare provider about your experience and the impact your period might be having on your life. To determine the underlying cause of the HMB, your healthcare provider may perform steps including (2,5,21):\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"A pelvic examination to ensure that the bleeding is coming from the uterus\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Blood tests to check several markers, including your iron levels\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"A pelvic ultrasound\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"For those at risk for endometrial cancer, an endometrial biopsy, where they take a sample of tissue from the uterine lining. As previously noted, this is necessary for a minority of women, most of whom are in their later reproductive years \",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"list-item\"}],\"nodeType\":\"unordered-list\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Based on the results, your healthcare provider may recommend additional tests to help understand the cause of your HMB and help guide your treatment (21). These could include a \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"hysteroscopy\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" (where a small camera is used to check the inside of your uterus) or further scans such as a \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"magnetic resonance imaging\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" (MRI)(5). \",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"How is heavy menstrual bleeding treated? \",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"The treatment for HMB depends on the cause. After your healthcare provider has evaluated your situation and found the potential cause or causes, treatment can be started. For most people, medical options are available that are often simple, safe, and effective, while for others, surgery is an option.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"For those with a suspected endometrial condition, there are common and often over-the-counter options, such as \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"nonsteroidal analgesics\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" (“NSAIDS”) or prescribed \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"tranexamic acid\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\", that can be effective and are taken only during the period (22).\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"On the other hand, an individual with a \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"leiomyoma\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" (fibroid) affecting the lining of the uterus (the endometrium) may benefit from a surgical procedure that can often be performed without incisions with a simple day-care procedure called \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"hysteroscopic myomectomy\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" (23).\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"For those with \",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\"polycystic ovary syndrome (\",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"1lEAb6QfDuqI6kUiuA4Uu6\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"PCOS\",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\"), hormonal therapy may be prescribed to help regulate or reduce bleeding. This is often achieved by using hormonal birth control that contains both \",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"3RKzDbEfGfZGWZfxXQK0qp\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"estrogen\",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\" and \",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"2YZ4yMyes0SsmnOT9w6wO9\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"progestin\",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\" (22).\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"When to see your healthcare provider\",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Generally speaking, it’s a good idea to consult your healthcare provider if your menstrual flow affects your quality of life, as, by definition, you have HMB. Your symptoms may extend outside the days of your period. Most people with HMB will have iron deficiency and may be anemic, meaning you could feel tired and have difficulty concentrating throughout the month.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Additionally, if you notice bleeding between your regular periods, after having sex, or after menopause, schedule an appointment with your healthcare provider.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"blockquote\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"If you’re pregnant or think you could be pregnant, it’s important to speak to your healthcare provider if you experience an episode of what you think might be HMB. Bleeding in pregnancy should always be investigated, as it possibly indicates problems that could include a miscarriage or an \",\"nodeType\":\"text\"},{\"data\":{\"target\":{\"sys\":{\"id\":\"6knEM6LnRPbmsaIuQIkFur\",\"type\":\"Link\",\"linkType\":\"Entry\"}}},\"content\":[{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\"ectopic pregnancy\",\"nodeType\":\"text\"}],\"nodeType\":\"entry-hyperlink\"},{\"data\":{},\"marks\":[{\"type\":\"italic\"}],\"value\":\",\",\"nodeType\":\"text\"},{\"data\":{},\"marks\":[],\"value\":\" where the pregnancy may be present outside the uterus, which can be life-threatening (24). Consequently, getting advice from your healthcare provider if you experience a sudden change in bleeding pattern or volume is important.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"If you experience sudden and unusually heavy bleeding, this could be acute AUB. Acute AUB refers to an episode of heavy bleeding that is heavy enough to require immediate intervention to prevent further blood loss (25). It can happen as an isolated event or may occur in someone who has an ongoing history of heavy and/or irregular bleeding. The possible causes of acute AUB are the same as listed above. Acute AUB is typically treated with medication first, but in some cases, surgery may be required, depending on the cause (26).\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Heavy menstrual bleeding is treatable\",\"nodeType\":\"text\"}],\"nodeType\":\"heading-2\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Dealing with heavy menstrual bleeding can be frustrating and may make you feel isolated. But you don't have to cope with it alone. The good news is that help is available, and the causes and consequences of HMB are generally highly treatable.  \",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"If you have HMB, reaching out to your healthcare provider for guidance may be a good place to start. Identifying the underlying condition causing the heavy menstrual flow is the first step in getting the appropriate treatment to improve your quality of life.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"},{\"data\":{},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"\",\"nodeType\":\"text\"},{\"data\":{\"uri\":\"https://app.adjust.com/1a9z9cex\"},\"content\":[{\"data\":{},\"marks\":[],\"value\":\"Tracking your menstrual cycle more closely with the Clue app\",\"nodeType\":\"text\"}],\"nodeType\":\"hyperlink\"},{\"data\":{},\"marks\":[],\"value\":\" can help you gather helpful insights to share with your healthcare provider. You can track details about how heavy your bleeding is, from ‘light’ to ‘super heavy’, and use tags to add details about extra symptoms like blood clots. Being open and providing as much information as possible with your healthcare provider can help you get the answers and support you may need.\",\"nodeType\":\"text\"}],\"nodeType\":\"paragraph\"}],\"nodeType\":\"document\"}","references":[{"__typename":"ContentfulAppDownloadWidget","contentful_id":"1jCaKiuJgeFMJNCUU0nG98","message":"Download Clue to track the regularity of your period","secondaryMessage":null,"showSecondaryMessage":null,"showStarRating":true,"colour":"web berry","iosUrl":null,"iosMessage":null,"iosSecondaryMessage":null,"androidMessage":null,"androidSecondaryMessage":null,"image":null,"iosImage":null,"androidImage":null,"sys":{"contentType":{"sys":{"type":"Link","linkType":"ContentType","id":"appDownloadWidget"}}}},{"__typename":"ContentfulArticle","contentful_id":"4U1VNSG648c2aWS6Goc6UW","title":"What’s “normal”?: menstrual cycle length and 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Abnormal Uterine Bleeding. Obstet Gynecol Clin North Am. 2019 Dec;46(4):595–605.\n2.\tCDC. Centers for Disease Control and Prevention. 2022 [cited 2024 Apr 2]. Heavy Menstrual Bleeding | CDC. Available from: \n3.\tBofill Rodriguez M, Dias S, Jordan V, Lethaby A, Lensen SF, Wise MR, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta‐analysis. Cochrane Database Syst Rev. 2022 May 31;2022(5):CD013180.\n4.\tKaunitz AM. Abnormal Uterine Bleeding in Reproductive-Age Women. JAMA. 2019 Jun 4;321(21):2126–7.\n5.\tHeavy Menstrual Bleeding [Internet]. [cited 2024 Apr 2]. Available from: \n6.\tnhs.uk [Internet]. 2021 [cited 2024 Apr 2]. Heavy periods. Available from: \n7.\tDysmenorrhea: Painful Periods [Internet]. [cited 2024 Apr 2]. Available from: \n8.\tMunro MG, Balen AH, Cho S, Critchley HOD, Díaz I, Ferriani R, et al. The FIGO ovulatory disorders classification system. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2022 Oct;159(1):1–20.\n9.\tKennedy KER, Onyeonwu C, Nowakowski S, Hale L, Branas CC, Killgore WDS, et al. Menstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sample. J Sleep Res. 2022 Feb;31(1):e13434.\n10.\tMunro MG. Heavy menstrual bleeding, iron deficiency, and iron deficiency anemia: Framing the issue. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2023 Aug;162 Suppl 2:7–13.\n11.\tBorzutzky C, Jaffray J. Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA Pediatr. 2020 Feb 1;174(2):186–94.\n12.\tMcGrath M, Quint EH, Weyand AC. Depression in adolescents and young adults with heavy menstrual bleeding in a referral clinic setting. Am J Hematol. 2021 Apr 1;96(4):E105–8.\n13.\tWeyand AC, Fitzgerald KD, McGrath M, Gupta V, Braun TM, Quint EH, et al. Depression in Female Adolescents with Heavy Menstrual Bleeding. J Pediatr. 2022 Jan;240:171–6.\n14.\tDutton B, Kai J. Women’s experiences of heavy menstrual bleeding and medical treatment: a qualitative study in primary care. Br J Gen Pract. 2023 Mar 7;73(729):e294–301.\n15.\tThe Centre for Menstrual Cycle and Ovulation Research [Internet]. 2017 [cited 2024 Apr 2]. Very Heavy Menstrual Flow. Available from: \n16.\tMunro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2018 Dec;143(3):393–408.\n17. Berceanu C, Cernea N, Căpitănescu RG, Comănescu AC, Paitici Ş, Rotar IC, Bohîlţea RE, Olinca MV. Endometrial polyps. Rom J Morphol Embryol. 2022 Apr-Jun;63(2):323-334. doi: 10.47162/RJME.63.2.04. PMID: 36374138; PMCID: PMC9804076.\n18. Zhai J, Vannuccini S, Petraglia F, Giudice LC. 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Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014 Mar 1;20(2):250–61.\n25.\tMunro MG, Critchley HOD, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2011 Apr;113(1):3–13.\n26.\tManagement of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women [Internet]. [cited 2024 Apr 2]. Available from: "},"partnerships":null,"relatedArticles":null,"articleFooterDownloadWidgetText":null},"recommendedArticles":{"edges":[{"node":{"id":"4qbkbUS0kweSg8YgqmG2sM","title":"How much period blood is normal?","slug":"cycle-a-z/what's-normal-period-volume-and-heaviness","snippet":"You can expect around five tablespoons of blood during menstruation, but every person differs. 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